VOLUME 15 • NUMBER 8 march 2011

Never too late: Exercise helps late starters INSIDE Meat or beans: What will you he Industrial Revolution changed investigation, the men were evaluated five have? Part II: Beans. . . . . 4. America forever, and the Information times, at ages 50, 60, 70, 77, and 82. At each Beans are humble but nutritious— Era has changed it still further. More evaluation, the men submitted detailed and with a few tips, they can Tthan ever before, men are working with their information about their exercise, smoking, improve your diet and your health. brains instead of their backs. It’s great prog- and drinking habits, and the researchers Obesity: Unhealthy ress, but it does have unintended con- measured body height and weight, and unmanly ...... 6. sequences, including global economic blood sugar and cholesterol levels, and Gents who man-up and chow down competition and unprecedented lev- blood pressure. in the face of heart disease and els of stress. Another consequence is The researchers divided the men other well-publicized consequences of obesity may think again when it diminished physical activity. Now that into three groups based on their exer- comes to sexual dysfunction, most men don’t need to exercise to earn cise levels. At age 50, most of the prostate disease, and other their keep, many view exercise as kids’ stuff, men rated their own health as good, and maladies of men. the fun and games that fill childhood—or there was little difference in body mass index, On call...... 8. used to in the days before video games and blood pressure, or cholesterol between the Screening for peripheral flat-screen TVs. low-, moderate-, and high-exercise groups, artery disease. America has become a nation of specta- but smoking was less prevalent in high- versus Testing is safe, easy, and inexpensive tors. That deprives men of the exercise that low-level exercisers (47% vs. 61%). Over or even free. But is it right for you? improves cholesterol levels, lowers blood the next 35 years, though, major differences In future issues sugar, burns away body fat, strengthens in health emerged. Most importantly, men Bladder cancer muscles and bones, improves mood and who were highly physically active at age 50 sleep, and protects against diabetes, demen- were 32% less likely to die during the study Beyond the coronary arteries: Possible benefits of statin drugs tia, certain cancers, and especially heart than those who were least active; moder- Acupuncture for ED? attacks and strokes. ately active men enjoyed a smaller, but still Men who stay physically active through- respectable, 13% lower death rate than the Abdominal aortic aneurysms out life reap these benefits and more. But least active gents. what about men who slide into sloth once The protective effect of regular exercise they’re too old for school sports? Can a late comes as no surprise. But the long-term start make up for years of sedentary living? nature of the Swedish study allowed the Second chances are rare in this life. But scientists to follow men who were sedentary when it comes to exercise, new research at age 50 but who increased their exercise What’s New reinforces earlier studies that tell older men level between ages 50 and 60. For the first 2011 Annual Report on not to act their age. five years, the major result was disappoint- Prostate Diseases ment, since these men continued to die at Understanding Depression Starting late in Sweden the same high rate as men who remained Special Health Reports from Harvard Medical School A 35-year study from Sweden provides strong inactive. But over the next five years, the To order, call 877-649-9457 evidence that starting to exercise late in life benefit kicked in; by 10 years of follow-up, (toll-free) or visit us online is better than never starting at all—much the men who adopted exercise in middle at www.health.harvard.edu. better, in fact. age enjoyed the same low mortality rate The subjects were 2,205 male residents as men who began before age 50. All in CONTACT US of the municipality of Uppsala. All the men all, men who adopted exercise after 50 had Write to us at were between the ages of 49 and 51 when a 49% lower death rate than the men who [email protected] they volunteered for the study between remained inactive, a benefit even greater For customer service, write us at 1970 and 1973. During the course of the than the 40% risk reduction experienced [email protected]

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by men who quit smoking after age Knowledge Is Power 50. And the protective effect of exer- Turning back the clock Editorial Staff cise remained significant even after the Editor Harvey B. Simon, M.D. Ponce de Leon learned it the hard way: Editorial Assistant Kathleen Sweeney Laing scientists adjusted their results for the There is no fountain of youth. But an Copy Editor Pat Cleary impact of smoking, drinking, obesity, Art Director Heather Derocher interesting study tells us that exercise Illustrator Harriet Greenfield, M.A. diabetes, cholesterol, blood pressure, can make arteries act younger. Production Coordinator Nicole Wall and socioeconomic status. editorial board As people age, their arteries tend to Board members are associated with Men looking for an excuse to stay on Harvard Medical School and affiliated institutions. the couch may suspect a catch, won- constrict (narrow), reducing the tissue’s Cardiology Patrick T. O’Gara, M.D. supply of oxygen-rich blood. To find out Endocrinology Gilbert H. Daniels, M.D. dering if they have to become long- Gastroenterology Stanley J. Rosenberg, M.D. distance runners to benefit from taking if exercise can improve age-related vas- Internal Medicine Christopher M. Coley, M.D. cular function, scientists compared 13 Stephen E. Goldfinger, M.D. up exercise in midlife. Quite the reverse. Russell S. Phillips, M.D. According to the Swedish study, men healthy men with an average age of 27 Neurology Colin McDonald, M.D. and 15 healthy men with an average Oncology Marc B. Garnick, M.D. were classified as moderate exercisers Orthopedics John M. Siliski, M.D. if they simply took frequent walks or age of 62. As expected, the older gents’ Otolaryngology Gregory W. Randolph, M.D. arteries were more prone to constrict Preventive Medicine Edward L. Giovannucci, M.D. often went cycling for pleasure. And Psychiatry Greg L. Fricchione, M.D. and less apt to dilate (widen). But for high-level exercise involved a minimum Radiation Oncology William U. Shipley, M.D. the next three months, eight of the Surgery David W. Rattner, M.D. of just three hours of serious gardening Urology William C. DeWolf, M.D. older men began an exercise program, Niall M. Heney, M.D. or recreational sports a week. And in averaging nearly five hours a week of case you’re tempted to cook up another CUSTOMER SERVICE moderate aerobic training. At the end Call: 877-649-9457 (toll-free) excuse, you’ll soon see that this impor- E-mail: [email protected] of that time, the arterial function tests Online: www.health.harvard.edu/customer_service tant new study does not stand alone. letters: Harvard Health Publications were repeated, and the men who began P.O. Box 9308 to exercise in their 60s scored younger. Big Sandy, TX 75755-9308 Late bloomers in Britain Subscriptions: $32 per year (U.S.) The great 17th-century physician Back issues: Harvard Health Publications Between 1978 and 1980, scientists evalu- ($5 each) P.O. Box 9309 ated 7,735 men from 24 British towns. In Thomas Sydenham said, “A man is as Big Sandy, TX 75755-9309 old as his arteries.” Twenty-first–century Bulk StayWell Consumer Health Publishing 1992, researchers were able to re-evaluate subscriptions: One Atlantic Street, Suite 604 research suggests older men can use Stamford, CT 06901 5,934 of the men, who then had an av­ 888-456-1222 ext. 31106 (toll-free) erage age of 63 years. The scientists their legs to turn back the hands of 203-653-6266 their arterial clock. [email protected] tracked these men for an additional four Corporate sales StayWell Consumer Health Publishing and licensing: One Atlantic Street, Suite 604 years, comparing their risk of illness and Stamford, CT 06901 death to their amount of physical activity. [email protected] At each evaluation, the researchers col- life exercise were evident in men who Editorial correspondence E-mail: [email protected] lected information about recreational and already had heart disease by the time Letters: Harvard Men’s Health Watch 10 Shattuck Street, 2nd Floor occupational exercise, smoking, drink­ they became active as well as in men Boston, MA 02115 ing, social class, obesity, and health status, who were still healthy when they began permissions but they did not measure cholesterol, to exercise. Copyright Clearance Center, Inc. Phone: 978-646-2600 blood pressure, or blood sugar levels. Online: www.copyright.com As in the Swedish study, the British News from Norway

Published monthly by Harvard Health Publications, research revealed a strong link between A third European study, this time from a division of Harvard Medical School exercise and survival. Even light exer- Norway, confirms the findings from Editor in Chief Anthony L. Komaroff, M.D. Publishing Director Edward Coburn cise was protective, reducing the rate of Sweden and England. Beginning in 1972, death by 39%; moderate exercise was researchers evaluated 2,014 healthy men © 2011 Harvard University. (ISSN 1089-1102) Proceeds support the research efforts of even better, cutting the mortality rate who were 40 to 60 years old. When the Harvard Medical School. Harvard Health Publications by 50%. Most importantly, exercise was study began, each man got a compre- 10 Shattuck St., 2nd Floor, Boston, MA 02115 beneficial for men who were sedentary hensive medical work-up and an exer- The goal of the Harvard Men’s Health Watch is to in 1978–80 but who began exercising cise test. The evaluations were repeated interpret medical information for the general reader in a timely and accurate fashion. Its contents are not sometime during the next 12 to 14 between 1980 and 1982, and the scien- intended to provide personal medical advice, which should be obtained directly from a physician. We years; men who began to exercise later tists continued to keep track of the men regret that we cannot respond to inquiries regarding personal health matters. in life enjoyed a 45% lower mortality through 1994. PUBLICATIONS MAIL AGREEMENT NO. 40906010 rate than men who remained sedentary As in the other studies, men who RETURN UNDELIVERABLE CANADIAN ADDRESSES TO: CIRCULATION DEPT., 1415 JANETTE AVENUE, throughout. And the benefits of late- were physically fit enjoyed substantial WINDSOR, ON N8X 1Z1 E-mail: [email protected] 2 | Harvard Men’s Health Watch | March 2011 www.health.harvard.edu This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/ protection from cardiovascular dis- ease and early death; in all, the most Not by exercise alone fit men had a 55% lower mortality Men who become physically active later in life enjoy better health and a lower rate than the least fit. In addition, men death rate than men who remain sedentary. That’s good news for couch potatoes who took up exercise and improved everywhere—but will reforming other health habits in midlife also help? their fitness levels between 1972 and 1982 reduced their risk of dying dur- A study of 15,708 American men and women ages 45 to 64 says the answer is ing the study—but men who let their an emphatic yes. At the start of the study, only 1,344 people had all four of these exercise slide lost the protective effect healthy lifestyle habits: eating five or more servings of fruits and vegetables daily, of physical fitness. not being obese, not smoking, and exercising regularly. But over the next six years, another 970 people adopted the healthful habits. The late adopters were quickly American veterans rewarded with improved health; over the next four years they enjoyed a 35% lower risk of cardiovascular events and a 40% lower death rate than their peers who The benefits of catch-up exercise are failed to reform. not confined to Europeans. A 2010 study of 5,314 male veterans ages 65 to Exercise was one of the newly acquired health habits, but since the benefits of 92 shows that fitness pays off on both starting to exercise later in life take five years to kick in, exercise itself can’t account sides of the Atlantic. All the volunteers for these rapid improvements. Better late than never, and better all than one. underwent exercise tolerance testing It’s a simple but powerful message, but it seems to fall on deaf ears. Only 8% of at VA Medical Centers in Washington, Americans between the ages of 40 and 74 have all four of these health habits plus D.C., and Palo Alto, Calif. Researchers moderate alcohol use—and that percentage has actually declined from a still woe- followed the men for up to 25.3 years. ful 15% in 1988. During that time, the men who were most fit enjoyed a 38% lower mortality rate than those who were least fit. But style changes also helped, even if they you’re healthy. In addition to check- the men who began to exercise during did not occur until after age 45; quit- ing for diabetes, hypertension, abnor- the follow-up period nearly caught up ting cigarette smoking, maintaining mal cholesterol levels, and evidence with the men who were in shape at the normal blood pressure, and avoiding of cardiovascular disease, your doctor start of the study; unfit individuals who obesity were all associated with less should be sure your joints and muscles improved their fitness had a 35% lower heart disease and longer life. don’t merit special precautions. mortality rate than their peers who re- Which changes matter most? To • Pick an activity that’s right for you. mained unfit. find out, researchers evaluated some For many older gents (and for younger 36,500 male Harvard graduates and guys, too), walking is ideal (see Harvard men, too 21,000 male and female graduates of Harvard Men’s Health Watch, August These four studies that show it’s never the University of Pennsylvania. All in 2009). Biking and swimming are also too late to get fit confirm and extend all, sedentary individuals gained 1.6 excellent sports, and physically active the findings of an earlier American years of life expectancy from becom- hobbies such as serious gardening fill investigation that focused on middle- ing active later in life, smokers gained the bill, too. aged men. A 1993 report evaluated 1.8 years from quitting, and those • Set a realistic goal. Aim for 30 to 10,269 Harvard alumni who were 45 who maintained normal blood pres- 40 minutes of moderate exercise, such or older when the study began in 1977. sure gained 1.1 years. Best of all was as brisk walking, nearly every day. But Over the next eight years, researchers a combination of changes; sedentary don’t try to morph from couch potato tracked the effects of lifestyle changes smokers gained 3.7 years from quit- to jock all at once. Instead, start out on mortality. Previously sedentary ting and becoming active. gradually and build up to your goal men who began exercising after age 45 slowly but steadily. For example, you clearly benefited, enjoying a 23% lower Never too late may want to begin exercising for 15 rate of death than their classmates From both sides of the Atlantic, the minutes three times a week, and then who remained inactive. The maximum message is clear: exercise is beneficial add minutes and days as you improve. bene­fits were linked to an amount of for all stages of life, and it’s never too And even when you’re in top shape, it’s exercise equivalent to walking for about late to start. But men who start exer- always smart to alternate hard work- 45 minutes a day at a pace of about 17 cising after age 50 also need to exercise outs with easier ones and to vary minutes per mile. Not surprisingly, the caution. Here are some tips: your routine. Harvard study found that other life- • Get a check-up to be sure that • For best results, add stretching ex-

www.health.harvard.edu March 2011 | Harvard Men’s Health Watch | 3 This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/ ercises, which are ideal for warming and relatives who enjoy exercise and most cases, you’ll hear sounds of im- up before and cooling down after your know the tricks of the trade. Consider provement, but if you detect distress workout. Remember, too, that strength professional guidance from a trainer or signals—particularly chest pain or training will complement aero­bic pro, and don’t hesitate to spend a few pressure, undue fatigue or breath- training to build a balanced exercise bucks on good shoes or other gear. lessness, or an irregular heartbeat or program; all it takes is two to three ses- • Make exercise part of a compre- lightheadedness—back off and report sions a week (see HMHW, October and hensive health makeover. It’s particu- it to your physician. November 2009). larly important to avoid tobacco in all It’s never too late to start taking • Once you find yourself enjoy- its forms and to eat right, control your care of yourself, and it’s never too ing exercise, don’t be afraid to extend weight, reduce stress, get enough sleep, early, either. Whether you started yourself. Walkers, for example, might and get regular medical care. But just early or later, keep going throughout try a little jogging, golfers should walk as you’ve eased your way into exercise, life. And spread the gospel of exercise the course, and doubles tennis play- make the other lifestyle changes you for health to the younger generations, ers could switch to singles (or find need gradually, and don’t get down on who have grown distressingly fat and younger partners). yourself if you backslide. lazy. One of the best ways to lead is • Get practical advice from friends • Above all, listen to your body. In by example.

Meat or beans: What will you have? Part ll: Beans ed meat has long occupied a But men who decide to cut down on legumes (lentils, chickpeas, and dry special place in the American red and processed meat need alterna- beans and peas such as black, lima, diet. Although doctors and di- tives. Fish and poultry are excellent fava, pinto, kidney, and navy beans) Reticians have been hoisting red flags choices. These options are well known, and oilseeds (soybeans and—surprise— for years, meat has retained its iconic but another has been neglected. It’s a peanuts). Leaving peanuts aside, let’s status. In fact, new health warnings humble but healthful choice: beans. think about the nutrients in legumes. have done little to slow the surge in As a group, legumes are a good high-end steak houses, to say noth- Counting beans source of protein and dietary fiber. ing of the ongoing popularity of ham- When most Americans think of beans, They have no cholesterol and very burger restaurants. they think first of garden-type fresh little fat and sodium, yet they provide Last month, Harvard Men’s Health beans such as green beans, string beans lots of potassium and some calcium Watch reviewed new research show- and wax beans, and green peas. But nu- and iron as well as B vitamins. Table 1 ing a link between meat consumption tritionists think first of legumes. Bota- lists some facts about beans. and premature death, heart disease, nists tell us they are characterized by Men can’t live by beans alone, but colon cancer, and other malignancies. seed-bearing pods and include grain legumes can go a long way toward filling some of your important nutri- Table 1: Nutrients in legumes tional goals, including: fiber (38 grams a day before age 50, 30 grams Contents per portion (½ cup or about 3 ounces) of cooked beans a day after age 50), protein (about .36 Fiber Protein Calcium Iron Potassium Calories grams per pound of body weight, or (g) (g) (mg) (mg) (mg) about 65 grams—around 2 ounces— Black beans 114 7.5 7.6 23 1.8 305 for a 180-pound man), and potassium Chickpeas 135 6.3 7.3 40 2.4 239 (at least 2,000 milligrams a day; peo- (garbanzo beans) ple who have kidney disease may need Fava beans 94 4.6 6.5 31 1.3 228 to restrict potassium, as do those Kidney beans 113 5.7 7.7 31 2.0 359 taking medications that retain potas- Lentils 115 7.8 8.9 19 3.3 370 sium). Table 2 shows how beans can Lima beans 108 6.6 7.4 16 2.3 478 contribute to your daily goals for Navy beans 128 9.6 7.5 63 2.2 354 some other nutrients. Soybeans 149 5.2 14.3 88 4.4 443 Legumes and health Source: USDA Nutrient Database You don’t have to eat a hill of beans to

4 | Harvard Men’s Health Watch | March 2011 www.health.harvard.edu This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/ get a mountain of benefits. But men who eat beans regularly appear to have Soy and prostate cancer a reduced risk of prostate cancer, pre- cancerous colon polyps, and (in over- Prostate cancer is much less common in Asia than in the United States and weight individuals) pancreatic cancer. Europe. Soy consumption is high in Asia, low in America, but there are many addi- In these respects, legumes are the anti- tional differences between the Asian and Western lifestyles. For example, meat red meat—and the same is true when it consumption and obesity are more prevalent in the West and they appear to comes to metabolic abnormalities and contribute to risk. Studies of soy and prostate cancer have produced widely dis- cardiovascular disease. parate results, but a new meta-analysis of 15 studies of soy and prostate cancer An analysis of data from the National provides an interesting explanation for the variability. Health and Nutrition Examination Overall, a high consumption of soy foods was linked to a 26% reduction in the risk Survey found that people who eat of prostate cancer. But not all soy foods are created equal. Protection was associ- beans have lower body weights, smaller ated with nonfermented soy foods such as tofu and soy milk, but fermented soy waist circumferences, and lower blood products such as miso, natto, and tempeh did not appear beneficial. In addition, pressures than people who don’t eat studies of Asian populations generally reported protection, but studies of Western beans. Because of their high fiber con- populations did not. tent, legumes can also help control The humble soybean sure provides a lot of food for thought. blood sugar and cholesterol levels. All this should add up to better cardiovascular health, and it does. A Fortunately, gas doesn’t have to place on your legumes before you eat 19-year study of 9,632 American men be taxing. To minimize the problem, them. The same tactic may help with and women found that people who introduce legumes into your diet slow- other “gassy” foods, such as broccoli eat legumes four or more times a ly. Be sure to drink plenty of fluids. and cauliflower. week enjoy a 22% lower risk of coro- Before you cook dried beans, wash nary artery disease than those who eat them and soak them overnight or at Why not beans? legumes less than once a week. And a least for two hours; then rinse them Legumes are the neglected nutrients. 10-year Japanese study reported pro- and change the water before you boil They are inexpensive and tasty, but tection against stroke for women but them up. they do take some planning, both to not men. If gas is still a problem, try using cook them right and to eat them with- Legumes are nutritious and inex- a nonprescription enzyme that will out getting intestinal gas. Still, it’s not pensive. They can add flavor, color, start breaking down the carbohydrates inconvenience or even gas that has and texture to any menu. But there before the bacteria in your colon banished beans from the typical Amer- is a hitch: they can trigger bloating can get to them. Alpha-galactosidase ican diet. Instead, the problem may and flatulence. (Beano, generic) is available as tab- stem from cultural prejudices, since lets that you swallow before you legumes are a dietary staple in much The gas tax start eating or as drops that you of the developing world. One of the virtues of legumes is that Legumes come in almost end- they contain complex carbohydrates Table 2: Beans and nutritional goals less varieties: black beans, kidney that can’t be digested by human in- One-half cup of typical cooked beans will beans, navy beans, pinto beans, testinal enzymes. These carbohy- provide the following percentage of an black-eyed peas, green or yellow drates have very little caloric value average man’s daily needs. split peas, red or green lentils, but they are filling. Some help lower Folate 23% to 45% lima beans, soy beans, and chick cholesterol and blood sugar levels; Manganese 19% to 26% peas (garbanzo beans) are but a others make stools softer, bulkier, few of the legumes you can add Magnesium 10% to 15% and easier to pass. But there is a rub. to your menu. All are versatile Humans can’t digest these carbohy- Iron 11% and healthful. Soybeans are par- drates, but bacteria in the intestines Selenium 8% ticularly excellent as a source of can—and in the process, they pro- Zinc 6% to 8% protein, iron, and calcium; tofu is duce gas. Doctors know that beans Copper 8% to 15% used in many vegetarian recipes. are good for the heart, and school- Calcium 2% to 6% Remember, though, that commer- boys know that the more you eat, the cial processing can add undesir- Source: USDA Nutrient Database more you . . . pass gas. able amounts of salt and fat to

www.health.harvard.edu March 2011 | Harvard Men’s Health Watch | 5 This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/ legumes; canned baked beans and wonderful with grains, and the combi- in this tough economy. But the most split pea soups are examples of good nation provides a fine protein balance important goal is good health, which foods gone bad. as well as great taste. Legumes can requires a balanced, enjoyable, sus- Legumes will give you an oppor- be used as meat substitutes in many tainable diet (see HMHW, July 2009). tunity to enjoy recipes from around dishes. Leftover beans freeze well, so Small portions of meat are okay, but the world, such as black beans or you can always have a supply handy fish and skinless poultry are better kidney beans in chili (which can be for salads, soups, or casseroles. choices. Go heavy on whole grains, meatless or made with ground turkey), legumes, vegetables, and fruits. Go refried black beans, lentils in Indian Something to chew on light on salt, processed foods, sugar, dal or Hungarian Magyar stew, or Most men spend much more time eat- and whole-fat dairy products. Adjust navy beans in minestrone. For extra ing than cooking. Still, a gent can— your caloric intake and exercise level flavor, add spices to the water in which and should—help decide what goes on to control your weight. Add a drink or your legumes are soaking; try thyme his plate and down his hatch. Cutting two (but not more) if alcohol suits you. for lentils, cumin for kidney beans, down on meat and adding legumes is And make your menu a pleasure, not and garlic for black beans. Beans are a step in the right direction, especially a chore.

Obesity: Unhealthy and unmanly t’s no secret that overweight and Am I overweight? Obesity and testosterone obesity are big problems in the A look in the mirror can give you a clue, Testosterone is the major male hor- United States. At present, two- but to find out if your weight puts you mone. As such, it’s responsible for the Ithirds of all Americans need to lose at risk for genitourinary disorders, you deep voice, large muscles, and strong weight, and the number of overweight need a more precise assessment. bones that characterize our gender, for children and adults is growing at an At present, the gold standard is the development of the male reproductive alarming rate. body mass index, or BMI. You can organs, for sperm production and li- And it’s no secret that obesity is calculate your BMI by multiplying bido, and for the typical male pattern of bad for health. Excess body fat raises your weight in pounds by 703 and beard growth. After being converted to levels of LDL (“bad”) cholesterol and then dividing by your height in inches dihydrotestosterone, the hormone also triglycerides while also lowering HDL squared or by dividing your weight in spurs growth of the prostate, which is (“good”) cholesterol levels. Obesity kilograms by your height in meters a much less welcome sign of manhood impairs the body’s responsiveness to squared. Or, if you’re like most of us, for older gents. insulin, raising blood sugar and insu- you can skip the math and use an Testosterone levels surge at puberty lin levels. But obesity does more than online calculator (www.nhlbisupport. and peak in early adulthood, and then produce bad numbers: it also leads com/bmi) or use the chart in the after a few years of stability, the hor- to bad health, increasing the risk of January 2009 issue of Harvard Men’s mone begins a slow drift downward in heart attack, stroke, hypertension, dia- Health Watch to find your BMI. early mid­dle age. Because the drop in betes, gallstones, cancer, osteoarthritis, The BMI gives a reasonable esti- testosterone averages just 1% a year, obstructive sleep apnea, fatty liver, and mate of overall body fat. A BMI most older men retain normal levels. depression. All in all, obesity is a killer; between 25 and 30 puts you in the But anything that accelerates the in fact, obesity and lack of exercise are overweight category, while a reading decline can nudge some men into tes- responsible for about 1,000 American of 30 or more says you’re obese. But tosterone deficiency. deaths each day, and if present trends the BMI doesn’t tell you how your fat Obesity lowers testosterone levels. continue, they will soon overtake is distributed. Scientists know that For example, a 2007 study of 1,667 smoking as the leading preventable while no excess body fat is good, men ages 40 and above found that each causes of death in the U.S. abdominal fat is the most harmful one-point increase in BMI was associ- Obesity affects men and women variety. So to find out if you are at ated with a 2% decrease in testosterone. about equally. But you may be sur- risk, simply measure your waist at In addition, a 2008 study of 1,862 men prised to learn that men bear a par- your navel; for men, risk begins to ages 30 and above found that waist cir- ticular burden, since obesity takes a rise at waist circumferences above cumference was an even stronger pre- special toll on male hormones, sexual- 37.5 inches, and troubles mount over dictor of low testosterone levels than ity, and prostate health. 40 inches. BMI. A four-inch increase in waist

6 | Harvard Men’s Health Watch | March 2011 www.health.harvard.edu This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/ size increased a man’s odds of having a search has linked obesity to low sperm tific puzzles and paradoxes. Here’s an- low testosterone level by 75%; for com- counts and reduced sperm motility; other: prostate-specific antigen (PSA) parison, 10 years of aging increased German scientists reported similar levels rise as the prostate gland en- the odds by only 36%. All in all, waist findings in men between 20 and 30. larges, and although obesity appears circumference was the strongest single to grow the prostate, it also lowers the predictor of developing symptoms of Kidney stones PSA level. According to the 2001–2004 testosterone deficiency. And if you ED can cause great psychological pain National Health and Nutrition Exami­ doubt these two American studies, for men and their partners. Kidney nation Survey of Caucasian men ages just consider Australian research that stones are much less personal but cause 40 and older, each five-inch increase in found almost one in every seven obese much more physical pain. Stones strike waist circumference results in a 6.6% men could benefit from testosterone men twice as often as women, and obe- decline in blood PSA levels. But unlike replacement, a rate more than four sity increases a man’s risk. many prostate puzzles, this one has a times higher than in nonobese men. A Harvard study of 45,988 men ages solution. A study of 13,634 prostate 40 to 75 found that high BMIs and large cancer patients found that men with Erectile dysfunction waist circumferences are both linked to higher BMIs had lower PSA levels, not Although men with erectile dysfunc- an increased risk of kidney stones. Men because their prostates produced less tion (ED) often blame testosterone, who gain more than 35 pounds after PSA, but because obesity increases hormonal disorders account for only age 21 are 39% more likely to develop blood volume, so PSA is more diluted 3% of ED. But even with normal tes- stones than men who remain lean. Men in the blood. tosterone levels, men who are obese who weigh more than 220 pounds are have an increased risk of ED. For ex- 44% more likely to have stones than Prostate cancer ample, a Harvard study found that a men who weigh less than 150 pounds. Because obesity lowers PSA levels, it man with a 42-inch waist is twice as These American results don’t explain can make it harder for doctors to use likely to develop the problem as a gent the reason for the link, but research PSA measurements to detect pros- with a 32-inch waist. Brazilian research from Europe and Asia shows that over- tate cancer in overweight guys. That’s also linked abdominal obesity to ED, weight people dump excess amounts of a numbers game caused by an artifi- but only in men older than 60. And a calcium and other chemicals into their cial lowering of PSA. But obesity also California study reported that having a urine, where the chemicals form stones. has an adverse effect on the biology of BMI of 28 (overweight but not obese) prostate cancer. increased a man’s odds of developing Benign prostatic hyperplasia Research from around the world ED by over 90%. Benign prostatic hyperplasia (BPH) be- shows that extra body fat increases Establishing a link is one thing; find- comes more common as men get older. a man’s risk of developing prostate ing a way to improve erectile function, It also becomes more common as men cancer. An American Cancer Society another. But a Massachusetts study gain girth. study of 404,576 men demonstrated found that weight loss can indeed A Harvard study of 25,892 men the link: being overweight increases a improve things for overweight men found that waist circumference was man’s risk by 8%, being obese boosts with ED. Similar results were reported strongly associated with a man’s risk of risk by 20%, and being severely obese by Italian scientists who randomly developing BPH symptoms. Men with increases risk by 34%. And that’s not assigned 110 obese men with ED to a waists of 43 inches or larger were 2.4 all. Obesity increases the odds that diet and exercise program or to simply times more likely to need surgery for prostate cancer will spread beyond continue their usual care. After two BPH than men with waists smaller than the gland, and it also makes relapse years, more than 30% of the men in 35 inches. The Harvard research did after treatment more likely. In addi- the diet and exercise group had cor- not implicate BMI as an independent tion, obesity boosts a man’s chance of rected their ED without medication, risk factor, but a Baltimore study did. developing urinary incontinence after compared with less than 6% in the And scientists in Baltimore and China a radical prostatectomy operation. group that received their usual level of provide an explanation; they used Why is obesity such bad news for medical care. Men who lost the most ultrasounds and MRIs to measure the prostate cancer? Overweight men tend weight enjoyed the greatest benefit. prostate gland and found that men with to put off medical care and they have bigger bellies have bigger prostates. lower PSA levels, so delayed diagnosis Reproductive function is part of the explanation. But obesity Obesity takes a toll on sexuality, and it PSA levels also alters the metabolism of sex hor- may also impair fertility. American re- The prostate gland is known for scien- mones, which could affect the growth

www.health.harvard.edu March 2011 | Harvard Men’s Health Watch | 7 This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/ of prostate cancer. Most important, Why weight? tion to BPH and prostate cancer. perhaps, obesity increases the body’s In today’s America, being overweight is It’s hard to shed excess pounds, but it production of growth factors such as the norm—but it’s not normal. In fact, is possible. There is no quick fix, but there insulin and insulin-like growth factor 1 this common problem is one of the is a slow fix: adjust your diet to take in (IGF-1). Both increase the rate of cell things that make diabetes, high blood fewer calories and ramp up your exercise multiplication, and high blood levels of pressure, stroke, heart attack, and ar- to burn off more calories. It’s the manly IGF-1 have been linked to an increased thritis so common. And if that’s not bad thing to do, and the time to start is now. risk of prostate cancer, colon cancer, enough, it also increases the risk of male When it comes to improving your and other malignancies. maladies, ranging from erectile dysfunc- health, don’t weight.

on call with Harvey B. Simon, M.D., Editor

Peripheral artery disease screening My senior center is sponsoring a test to check for that everyone needs to pay attention to the root causes Q “peripheral artery disease.” The test is free, and they of atherosclerosis, including tobacco exposure, hyper- say it’s safe and painless. Do you think it’s a good idea? tension, unhealthy cholesterol levels, and lack of exer- cise. Since doctors and patients must work to improve Peripheral artery disease (PAD) is a form of athero- these risk factors in any case, they argue, screening for A sclerosis. In this case, cholesterol deposits produce PAD in asymptomatic people will add little beneficial blockages in the arteries that carry oxygen-rich blood information. Moreover, while testing may be safe and to your legs. Mild blockages don’t cause any symptoms, inexpensive, or even free, it may lead to treatments that but more substantial disease can cause leg pain when are unnecessary, costly, and even risky. you walk, which is called intermittent claudication. And At present, the USPSTF’s position seems sound—but severe narrowing will produce pain at rest or, worst of new developments may modify the situation. Some new all, critical tissue damage that requires urgent surgery or guidelines have changed important goals for patients even amputation. If that’s not bad enough, PAD also in- with atherosclerosis. For example, the blood pressure dicates an increased risk for heart attacks and strokes. treatment target for these folks has been lowered to About 8 million Americans have PAD, and the 130/80 millimeters of mercury (mm/Hg) or lower in- majority are men. Your doctor can screen for PAD stead of the 140/90 mm/Hg or lower that’s acceptable simply by asking if you have symptoms and by feeling for otherwise healthy people with hypertension. Simi- the pulses in your legs and feet. In addition, a painless, larly, the LDL (“bad”) cholesterol goal is 100 milligrams safe, simple test can detect PAD and estimate its sever- per deciliter (mg/dL) or lower instead of 130 mg/dL or ity. Called the ankle-brachial index, or ABI, it’s simply a lower. If studies show that ABI screening in asymptom- matter of using a special device to take blood pressure atic people actually helps achieve these goals and better readings in your arms and legs, and then comparing health, it may gain wider acceptance. the numbers. Since PAD is common and can be serious, and since the ABI is simple, safe, and accurate, screening sounds like a no-brainer. Indeed, many experts recommend it—but the authoritative United States Preventive Services Task Force (USPSTF) does not. They reason

Send us a question for On call Visit the Men’s Letter online: Harvey B. Simon, M.D., Editor, Harvard Men’s Health Watch www.health.harvard.edu/blog By mail: Harvard Men’s Health Watch By e-mail: [email protected] 10 Shattuck St., 2nd Floor (Please write “Ask the Doctor” in the Boston, MA 02115 subject line.) Because of the volume of correspondence we receive, we can’t answer every question, nor can we provide 8 | Harvard Men’s Health Watch | March 2011 personal medical advice. This Harvard Health Publication was prepared exclusively for ntavares - Purchased at http://www.health.harvard.edu/